Claire Berman, M.S., is a Health Communication Specialist and part of SAMHSA’s Homeless and Housing Resource Network team. She specializes in issues of health literacy, behavior change communication, narrative approaches, and cultural competency. She shares her reflections on the connection between health literacy and homelessness and lessons learned from the Institute for Healthcare Advancement’s Health Literacy Conference of May 2012.

I like to think of health literacy in this way:

Imagine sitting in an advanced calculus class (and for the purposes of this blog, imagine that the last time you studied math was over ten years ago). The professor is saying words and describing concepts you’ve never heard of before—integral, optimize, derivative, function, and infinite series. You are a smart person, but you can’t follow any of it. Before you leave, the professor turns to you and asks, “Do you have any questions?”

You are so lost in the discussion that you don’t even know where to begin. It feels too late to start asking questions now, and you’re afraid you’ll look stupid if you do—so you say no and quietly leave the room.

Now imagine that instead of a calculus class, it’s a doctor’s appointment, and you are a person experiencing homelessness. The last time you saw a doctor was ten years ago. You’ve never had much education around health, and the health issues you struggle with are fairly complex. Your level of health literacy is probably fairly low, which means that you are less likely to understand what your doctor tells you and less likely to ask questions. As a result, your health is likely to suffer.

This May, I attended the Institute for Healthcare Advancement’s Health Literacy Conference in Irvine, CA. The conference explored operational solutions to low health literacy, and it came as no surprise to me that much of the work being done in health literacy intersects strongly with the work being done in homelessness services.

The vast majority of us in the U.S. (nearly 90 percent) have “less than proficient” health literacy skills. We also know that people with certain experiences are especially likely to have low health literacy. Less education, less access to mainstream services, and higher levels of poverty often lead to the lowest health literacy.

People experiencing homelessness often have all of these risk factors, with enormous costs to their personal health and to our health care system.

The thing about health literacy that makes it so hard to “fix” is that it goes far beyond one single skill. Instead, it is a complex process that relies on reading, writing, verbal, and numeracy skills, among others. It’s about how we are able to find and understand health information, and what we are able to do with that information once we have it.

Can we understand the language? Do we have the basic math skills to understand and follow instructions on medication? Do we have the ability to formulate questions for our doctors, and the confidence to ask them? Do we have people we trust to help us when we don’t have these skills?

What I heard at the conference was a commitment from the health literacy field to find new and innovative ways to reach our society’s most vulnerable populations with appropriate health information. Homelessness service providers work hard to cultivate relationships with marginalized individuals—people who may not have any connections to health care at all.

Providers have the chance to be an important part of the solution. As a starting point, I’d recommend some great resources and methods for addressing low health literacy among clients, such as: